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Hse addiction services
Hse addiction services
Hse addiction services
Hse addiction services
Hse addiction services
Hse addiction services
Hse addiction services
Hse addiction services
Hse addiction services
Hse addiction services
Hse addiction services
Hse addiction services
Hse addiction services
Hse addiction services
Hse addiction services
Hse addiction services
Hse addiction services
Hse addiction services
Hse addiction services
Hse addiction services
Hse addiction services
Hse addiction services
Hse addiction services
Hse addiction services
Hse addiction services
Hse addiction services
Hse addiction services
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Hse addiction services

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  • 1. HSE Addiction Services Northern Area: LHO, Dublin Central. LHO, Dublin North West, LHO, Dublin North East Dr.Siobhan Rooney: Consultant Psychiatrist in Addictions Dr.Des Crowley: GP Co-Ordinator
  • 2. Content. <ul><ul><ul><li>Introduction </li></ul></ul></ul><ul><ul><ul><li>Historical Development of Addiction Services and the Numbers attending the Addiction Services in the Northern Area over the years. </li></ul></ul></ul><ul><ul><ul><li>Current Services and numbers attending. </li></ul></ul></ul><ul><ul><ul><li>4 Tier Service </li></ul></ul></ul><ul><ul><ul><li>Service User’s Pathway and Services available </li></ul></ul></ul><ul><ul><ul><li>Current Challenges </li></ul></ul></ul>
  • 3. Historical Development of Addiction Services. <ul><li>Developed as a harm reduction service in response to HIV epidemic in Dublin in the late eighties/early nineties </li></ul><ul><li>Enormous community opposition to the development of services. </li></ul><ul><li>Services developed in an Ad hoc bases/facilities often no suitable for purpose / </li></ul>
  • 4. Numbers registered on the Central Treatment List: 1994 - 2009 7107 6145 5433 5498 4215 2948 2238 1529 2001 2000 1999 1998 1997 1996 1995 1994 10668 10213 9760 9428 8962 8364 8155 7596 2009 2008 2007 2006 2005 2004 2003 2002
  • 5. Numbers registered on the Central Treatment List: 1994 - 2009
  • 6. Current Services and Numbers attending <ul><li>6 Drug Treatment Centres, 1 Mobile Clinic and a Central Pharmacy </li></ul><ul><li>13 Satellite Clinics. </li></ul><ul><li>CTL: August 2010 : 2040 methadone patients attending with 1997 registered at the end of this period. 7 new cases registered. </li></ul><ul><li>Waiting List: 9 </li></ul>584 (n= 39) Total: 1716 541 (n=25) 591 (29 Pharmacies) Community Pharmacists: 93 285 Total: 935 453 197 Attending GPs: (65 GPs: Level 2: 18, Level 1: 47) 493 916 631 Attending DTCs, satellite clinics etc. Dublin North East Dublin North Central Dublin North West LHO Area
  • 7. Graph 1. Illustrates the number of Service Users attending the DTC’s (Drug Treatment Centres) in the different area HSE. Total: 1370
  • 8. Graph 2. Illustrates the number of Service Users attending the Satellite Clinics. Total: 643
  • 9. The Drug Treatment Centre Board <ul><li>Tertiary Service. </li></ul><ul><li>Patients: </li></ul><ul><ul><li>Dual Diagnosis / Co-morbid Psychological morbidity: Anxiety and depressive disorders, PTSD, Personality Disorders. Psychotic Disorders, Major Mental Illness </li></ul></ul><ul><ul><li>Challenging and aggressive behaviours </li></ul></ul><ul><ul><li>Homeless </li></ul></ul><ul><ul><li>Service provision for areas not covered in the community by DTCs / Satellite Clinics </li></ul></ul><ul><ul><li>Young Person’s Programme </li></ul></ul>
  • 10. Numbers attending the DTCB, September 2010 2 229 249 Total 0 74 81 F 2 155 168 M Summary Total 0 39 43 Total North East 0 9 10 f LHO Dublin 0 30 33 M 8 1 104 114 Total Central 0 33 37 f LHO Dublin 1 71 77 M 7 1 86 92 Total North West 0 32 34 f LHO Dublin 1 54 58 m 6 New End of period During Period Gender CCA
  • 11. Services: <ul><li>Primary Care Services: Level 1 and 2 GPs, Community Pharmacies </li></ul><ul><li>Specialist Multidisciplinary Teams: </li></ul><ul><ul><li>Drug Treatment Clinics, Satellite clinics, DTCB </li></ul></ul><ul><ul><li>SASSY Team </li></ul></ul><ul><ul><li>Needle Exchanges </li></ul></ul><ul><li>Rehabilitation Services </li></ul><ul><ul><li>Talbot Centre </li></ul></ul><ul><ul><li>Soilse. </li></ul></ul><ul><li>Inpatient Residential Services </li></ul><ul><ul><li>Inpatient Drug Treatment Units: Cuan Dara / St.Michaels Ward, Beaumount Hospital. </li></ul></ul><ul><ul><ul><li>Stabilisation Programmes </li></ul></ul></ul><ul><ul><ul><li>Detoxification Programmes </li></ul></ul></ul><ul><ul><li>Residential Rehabilitation Unit: Keltoi </li></ul></ul>
  • 12.  
  • 13. Services: <ul><li>Prevention + Treatment + Rehabilitation </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li>Educational Officers: </li></ul><ul><ul><li>Interagency Collaboration </li></ul></ul><ul><ul><li>Primary Prevention , Harm Reduction, Tertiary Prevention </li></ul></ul><ul><ul><li>4 Health Promoting Settings. </li></ul></ul><ul><ul><ul><li>Schools and Youth </li></ul></ul></ul><ul><ul><ul><li>Community </li></ul></ul></ul><ul><ul><ul><li>Workplace </li></ul></ul></ul><ul><ul><ul><li>Addiction Service. </li></ul></ul></ul>
  • 14. Client Referral and Pathways: Drug Treatment Clinic in the community Service User: Opiate / Cocaine Initial Assessment: Nurse, Counsellor, GP, CWO, Urinalysis Discussion at clinical team meeting: Referrals to other members of the team and external referrals Referral to Other HSE Addiction Rehabilitation Services: Talbot Centre, Soilse. Residential Inpatient + Rehabilitation Services Referrals: Self, Family +Friends, GPs, Social Services, Statutory, Community Services, Outreach, Prisons, Hospitals, Psychiatric services, Maternity Services Referral to other services: i.e. SASSY Team, Addiction Psychiatry MDT Team: GPs, Nurse, Counsellors, Consultant Psychiatrist, Rehabilitation Integration Service, Outreach, CWO, Hepatitis C Nurse, Liaison Mid-wife, Sen.GA, Pharmacists
  • 15. “ Menu of Services” <ul><li>Biological: </li></ul><ul><ul><li>Medications / Substitution Treatments. Maintenance and detoxification programmes </li></ul></ul><ul><ul><li>Urinalysis </li></ul></ul><ul><ul><li>Viral screening and vaccinations,. </li></ul></ul><ul><li>Psychological: </li></ul><ul><li>Comprehensive Psychiatric assessment and Treatment Plan </li></ul><ul><li>Counselling and evidence based counselling interventions. </li></ul><ul><li>Psycho-Social and Rehabilitation </li></ul><ul><li>Rehabilitation Integration Services: Comprehensive assessment and Care –plan: Focusing on rehabilitation i.e. training schemes, CEE schemes, accommodation issues, support in preparation for detoxification and residential treatment and rehabilitation. </li></ul><ul><li>CWO: in 1 LHO area: Advising on benefits and advocating for clients in being able to access benefits. </li></ul><ul><li>Greater need for family involvement </li></ul>
  • 16. Client Referral and Pathway: Soilse: Rehabilitation Day Programme: Goals: Stabilisation of Drug Use and Detoxification. Service User Team + Activities: Keyworker, Educators, counsellors, Career Guidance, Literacy, Health+Fitness, Art, Drama, creative pursuits Comprehensive assessment: Appointed Key worker and development of Care-plan. Preparation for detoxification, Personal development. 1:1 and Group work Interagency Working Rehabilitation Integration Services, residential drug treatment units and residential rehabilitation Units. Partnership: Soilse: Rutland Referral: Self, rehabilitation Integration Services, Treating clinic team, Probation etc as per treatment clinic .
  • 17. The Talbot Centre: is a dedicated Prevention service for children, young people and their families whose lives have been affected by drugs / alcohol in the North Inner City. Client / Service User/ Family Team: 1 Education Officer, Project Leaders x 2 (1WTE) 3 Project Workers Comprehensive assessment Allocated Keyworker and development of Care-Plan Collaboration, Interagency Working. Case -management Educational: Prevention Advocacy, Counselling, Family Therapy, Outreach Referrals: Family, community groups, SASSY Team, Social Workers, Crinian Project, JLOs. Courts, residential Care Centres, Family Support Network, LDTFs
  • 18. S.A.S.S.Y. ( S ubstance A buse S ervice S pecific to Y outh ) Team <ul><li>1 psychiatrist + 0.6 counsellor </li></ul><ul><li>Lack of staff severe </li></ul><ul><li>Cover all North Dublin city & county </li></ul><ul><li>Assess and treat all U-18 drug and /or alcohol users from catchment area (all drugs) </li></ul><ul><li>Do not need to be drug free to attend </li></ul><ul><li>Assess mental health </li></ul><ul><li>Offer 1:1 psychotherapy </li></ul><ul><li>Medication if required </li></ul><ul><li>Advise re risky behaviours </li></ul><ul><li>CBT / MI approach </li></ul><ul><li>Multi-agency liaison </li></ul><ul><li>Worked with 136 last year </li></ul><ul><li>1 prison clinic per week </li></ul><ul><li>2 sessions at YPP DTCB </li></ul><ul><li>Advice & education role- often country wide via phone </li></ul><ul><li>High risk groups in care </li></ul><ul><li>Early intervention for tomorrow’s problems </li></ul>
  • 19. Inpatient Drug Treatment Units: Beaumount Hospital and Cuan Dara, Cherry Orchard Hospital <ul><li>Stabilisation Programmes: </li></ul><ul><ul><li>Maintain on methadone maintenance </li></ul></ul><ul><ul><li>Detox. from other drug / alcohol use </li></ul></ul><ul><li>Detoxification Programmes : </li></ul><ul><ul><li>Detoxification from Methadone 40mg / 50mg </li></ul></ul><ul><ul><li>Has attended for counselling and has aftercare plan </li></ul></ul><ul><ul><li>St.Michael’s Ward: 4 weeks </li></ul></ul><ul><ul><li>Cuan Dara: 6 weeks: 3 weeks medical detoxification, 3 weeks Drug Free </li></ul></ul><ul><ul><li>1:1 Counselling, Group Work </li></ul></ul>
  • 20. Keltoi: HSE Residential Rehabilitation Unit: Drug Free, 8 Week Programme: Service User Comprehensive assessment process: Pre-admission group and urinalysis: Drug Free Team and Supports: Manager, Keyworkers, residential care workers, counsellors, family therapy, catering tutor (vacant),CWO, Educational supports: VEC, Literacy, Fitness, gardening. Allocated Keyworker and development of care-plan: Living Skills and capacity building Referrals: Self, Residential detoxification Units, Rehabilitation Day Programmes, Rehabilitation Integration Services and clinical teams, Community GPs Aftercare: 2 years, 1:1 counselling. Supportive housing / step down facilities, Day Programmes. Ongoing liaison with other services
  • 21. Keltoi: Residential Drug Free Rehabilitation Unit. <ul><li>Feb. 2001 to Dec. 2009. </li></ul><ul><ul><li>Total admissions: 414 , Total completed treatment: 314 </li></ul></ul><ul><ul><li>Total No. of assessments: 1278 </li></ul></ul><ul><li>Since 2007: 90% Completion rate </li></ul><ul><li>Outcomes at 1-3 years and compared to other research. </li></ul>60% free of all drugs except alcohol between 1 and 3 years 41% free of all drugs except alcohol at 1 year 23% free of opiates at 2-3 years Outcomes Keltoi (Residential rehabilitation n=85) Rosie Study (Residential rehabilitation nationally: N=81) Smyth et. al. (n=113, Cuan Dara, inpatient detoxification unit) Research
  • 22.  
  • 23. Future Challenges <ul><li>Drug Treatment Clinics: </li></ul><ul><li>Development of a Comprehensive assessment  Key Worker assigned  Development of a care plan. </li></ul><ul><li>Case Manager and case management if required. </li></ul><ul><li>Greater Interagency Working grounded by Interagency Protocols </li></ul>
  • 24. National Drug Rehabilitation Implementation Committee: Framework Document Aftercare Transition Programmes (e.g. structured pre-induction) Budgeting & Money Management Family Support & Childcare Justice, Law and Criminal Issues Support Education & Training, Personal Development Housing & Tenancy Support & independent Living Community Integration, Social & Recreational Activities Employment (including community employment), Work Placements General Health Services, Health Promotion, Mental, Physical and Intellectual Disability etc Drug Specific Interventions Service User
  • 25. Future Challenges <ul><li>Change of Philosophy </li></ul><ul><li>Negative Public Image of services </li></ul><ul><li>Changing Needs of Service Users </li></ul><ul><li>Financial Pressures and pressures of the Moratorium </li></ul><ul><li>Homeless Strategy and impact on services </li></ul><ul><li>Reconfiguration of Services </li></ul>
  • 26. Aims of Services <ul><li>To support Service users in services based in their locality and at a Tier that meets their needs. </li></ul><ul><li>To promote stabilisation and detoxification and transfer of service users to primary care services. </li></ul>
  • 27. <ul><li>Thank You </li></ul><ul><li>Questions </li></ul>

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